Interviewing for future Deputies

I’ve been interviewing people for a job opening in my office, a Deputy Coroner position. It has been an interesting process, at times even enjoyable. However, before anyone gets fired up to send me a resume, we are not taking any more applications at this time.

Nearly 100 people applied with a wider range of backgrounds than you might think. (Before you say it is not surprising to get that many applications for such a high profile job read on) Reviewing those applications, I (actually my Chief Deputy and I) winnowed them down to about 20. Those 20 are the individuals going through the interview process currently. One thing has amazed and irritated me, the answers I am getting to my second question of the interview:

Tell me what you know about the Coroner business.

It has amazed me how many of the interviewees can not give me a reasonable answer to that question. I am irritated that they apparently didn’t really care enough to find out something about what we do before they would apply for a job in the field. Every one of those individuals gets scratched from the list immediately. With the availability of the Internet to query about every topic one could imagine and with what seems to be 40 or 50 Coroner-related TV shows on the air, it shouldn’t be that hard to do a little research before you decide this is the field you really want to get into. Are people lazy? Do they not care? Obviously they are clueless about whether this is the field that they want to make their profession. I am looking for individuals committed to this field of endeavor; committed to this as a profession, not a passing fancy (and I do have some of those aps too,just not as many as I thought I would).

If one of those still scheduled to come in for an interview happens across this rant, know the answer to that question or save us both time and don’t come in.

Worth a read: Fast, Furious, Dead

Eric Zorn: Fast, Furious, Dead (Lake County 17 year old dead in car crash)

Bad choices are bad choices any day

Bad choices and taking chances does not take a holiday, it certainly was that way this last “weekend”.

As summer progresses we need to keep in mind (I was going to say we adults, but it is really the teens that need to keep it in mind) that too many teens die in car crashes and that the peak month, nationally, for teen car crash related death is July. I assure you I will remind my 15 year old (very soon to be 16).

Be careful, make good choices, don’t take chances.

Making it personal

When family attends an inquest I offer them the opportunity to make a statement after the verdict, which then becomes part of the inquest record/transcript. Most families choose not to make a statement or offer simple thanks to the jurors and those who have participated in the investigation and handling of the case. Some families, on the other hand, present a prepared statement. Yesterday we heard (and felt) such a prepared statement.

After thanking the jurors for their work, the young man’s mother said she wanted to communicate what her son was like before he died, so that the jury would have a concept of what he was like as a person. Her statement was emotional and heartfelt; it brought tears to several of the jurors. She spoke briefly, but it came across powerfully. She summed up her son’s personality, attributes and future aspirations, all of which had been cut short by his death at an early age. It was tough listening, but a great reminder that the decedents that could easily be viewed as statistics are individuals with personality, friends, family, potential, and real lives. It was a poignant reminder to not lose sight of that, the personal side of this business.

Obesity kills in car crashes

The other day I came across an interesting article in an on-line medical journal I read that caught my eye. I don’t recall a mention on the news like I would have expected. Had it been mentioned it would have been headed something like “Another major health risk for obese males”.

The study published in the American Journal of Public Health looked at car crash fatalities (limited to drivers) and culled out information on obese individuals. It found that obese males were more likely than were other individuals to die as a result of the injuries they received in a car crash. This did not hold true for women, which they were at a loss to explain. The risk of death increased (as you might expect) with increased speed at the time of the crash, but what did seem surprising was that use (or non-use) of seatbelts and deployment of airbags did not impact the risk of death. They did mention that the study was not designed to separate out some of the factors that may have contributed to the death in addition to the fact that these individuals were obese. The other factors “kill” more as a complication of the obesity than the kinetics involved in the crash. Some of those factors that may have contributed to the deaths of these drivers include comorbidities (other medical problems related to or unrelated to their obesity), as well as emergency care and peri-operative and postoperative problems associated with their obesity.

The “bottom line”, however, is that obese men are more likely than other individuals to die when they are drivers in auto crashes. This should be listed among the other medical/death risks of obesity in men. Obese men ought to be made aware that this is yet another reason to loose weight, unless they want to arrive in my office earlier than they ought.

Emo II

One last comment regarding the “emo” article that I posted about yesterday:

Music can accomplish much: it can set a mood and it can change a mood, but to credit it with inciting an action foreign to the thoughts of an individual is to give it more power than it has. It can soothe the savage beast because at times the savage beast is naturally soothed. Music will not cause someone to commit suicide unless it is validating thoughts that that individual already has. The suicide is not in the music, but in the mind of the individual who acts.

Not that I like a lot of what passes for “music” now (I did see something recently regarding the brain getting “wired” at a younger age than I am now as to what music it likes, making “appreciation” of “newer music” much more difficult).

I certainly dislike and do not support angry, cruel, violent, misogynist lyrics in some music today. I do think that those lyrics (along with much of current TV and movies) “desensitize” people, allowing us to slide into a less humane society. That should be addressed, but don’t write off action as the result of “music” (or movies or TV) and feel that all we have to do is eliminate the “music”.

Don’t “treat” the “music”, treat the individual, encourage the individual to get treatment.

Emo

Emo. It/they deserve better than the article in the Chicago Tribune yesterday. They don’t deserve the “cute” article title. They deserve better than to all be lumped into a category of trying “the latest cool thing”.

“Emo” is a broad, non-heterogeneous categorization. Some of these teens (even that age bracket is an over-simplification) are in it for the look. Some are in it for the shock value. Some so that they can belong to a group or have an identity. The attendant psychological symptoms run a spectrum from “normal” to personality disorder to major depression with high risk of suicide. To deal with these teens (to interact with them, to live with them) you must be able to separate out those in the “group” who are at real risk (although to a certain extent there is always risk).

Emo groups on MySpace are not necessarily a bad thing. While some will receive feedback/reinforcement that will increase their downward depressive and suicidal spiral, others may be helped by knowing that they are not alone and are able to discuss issues more anonymously and with less stigma (I don’t agree with the article’s statement that many believe “it is ultra-cool to have such mood swings that you are on prescription meds”, more often in my experience the converse of stigma reins).

Prescription medication swapping is certainly a significant and growing problem. I have seen deaths related to folks doing just that. The swapping frequently happens at parties, often mixed with alcohol. The dangers involve not only taking meds prescribed for someone else and mixing substances with a “Russian Roulette” uncertainty of combined effects, but also the consequences of not taking the meds you are prescribed (many psych meds, if stopped abruptly, cause a profound negative rebound/compound of symptoms). Anti-prescription swapping education must be pursued (it is a bigger problem than often thought), not in a fear-inciting way but honestly laying out the possible consequences (combat the “they’re prescription meds, so they must be safe” mentality).

I do agree with the article that “cutting, or self-injuring, that is… most worrisome…”. Cutting is scary. Not, as the article incorrectly states, because you might inadvertently kill yourself, but because it can be addicting, as powerfully as any drug (maybe more so). You are not likely to accidentally cut yourself bad enough to bleed to death. That requires a calculated, willful act; the arteries are relatively deep. The cutting these kids (and adults) undertake is meant to hurt. That hurt can give its own release, it can validate that you exist, it can prove that you can feel. It is scary. That behavior, just like a drug, can spiral into far deadlier activities. A cutter needs help, real serious help, now.

An “emo” teen must be seen as an individual, talked to like an individual, treated as an individual, not as a member of a category or a group identity. Don’t assume that they are trying to be “hip”. Don’t pander. Don’t dismiss. Don’t write/read a “fluff” piece and try to pass it off as investigative reporting (with quotes from “experts”). Don’t assume teens with problems will flag themselves as “emo” (actually most folks with the most severe problems won’t and/or can’t because it takes too much “energy”). As Steve Rhodes wrote in The Beachwood Reporter: “let’s investigate the real sources of their pain”.

Pre-Prom Event "Fix"

There were pre-prom crash reenactments both yesterday and today at different high schools. I have my doubts regarding their effectiveness in impacting behavior of the teens who attend and I talked with people at these events (and other similar events) who share that opinion. Most of the time these teens weren't "hooked" into the event. Looking at the crowd of teens there were, however, parts of the events that affected those attending (I will never know if it impacts their behavior). The portions of the events that seem to be most “affective” and really get their attention are in keeping with a line from my usual presentation at these events:

“You read about these tragedies in the paper and see them on the news. But, until you see it up close and talk to those involved it is far away, less than real. Young people think they are immortal, invincible.”

What grabbed the attention and brought tears to the eyes of at least some of these teens were the stories told by those involved in drunk driving (or risky driving) related car crashes. At one of the events a young man now wheelchair bound as a result of such an crash and today the parents of a young woman who died because her vehicle was struck by a drunk driver. Emotional, personal stories. Affective, effective stories.

That is where the “wow” factor is to truly get someone’s attention and, just perhaps, impact/change their behavior. Get rid of the reenactment. Let these people tell their story, tell their lives, get personal.

Think, make good choices, don’t take chances.

Love those questions

A variety day, today. Pre-prom event this morning and it started raining just as I finished speaking sending the teens running for the school to hear the final speaker. I’ll write some more about that tomorrow, after another pre-prom event scheduled for the a.m.

Also, today I listened to a presentation of a software program to improve our handling of documentation and track our tox lab, etc. Pricey. There will be others to review.

I was working on some questions sent to me by a student in the Las Vegas area that she needed answers to for a school project. In addition, I was interviewed by a local student working on a similar project. It is fun doing these, makes me think and often look at things in different ways. Some of the questions a truly “different” and can be challenging to come up with an answer for, let alone a good one. I do love challenges like those.

One question that occurred in both sets of questions, although in somewhat different forms was: What benefits do you receive as coroner? Really the benefit I like the most is the “credentials” as an expert I received when I was elected. Did it make me a different person? No. Did it expand my knowledge? Not directly, although I have done some educational activities to expand knowledge in certain areas pertaining to the office. (I have always known it is important to be a life-long learner.) None the less people are now listening to me because I am the coroner and I have been invited to speak places that I wouldn’t have been invited to when I was “merely” the Executive Director of a free medical clinic, although I am speaking about stuff I knew then too.

I am glad for that, it is one of my favorite things and it is the benefit I most enjoy as coroner. Keep those invitations coming. I do want to forestall death and I’ll try not to talk you to death.

Meth Myth II

According to the DEA, meth seizures peaked in 1989 with 174 million “doses” seized. In 2002 118 million “doses” were seized.

University of Michigan’s Monitoring the Future Survey found, in questioning high school teens about drug use, peak amphetamine use in 1981 at 26%. Methamphetamine use was less than 3% in 2005.

As has happened repeatedly throughout the past, people have become obsessed with a single drug to the point of near hysteria, meth this time around. Hazards have been exaggerated. This focusing on one drug as the main cause of increasing societal problems rather than accepting it as one of many causes is problematic. This inappropriate narrowing of focus (and funding) allows for inattention to the other societal problems, and forces cuts elsewhere. More general programs to address drug use and abuse get trimmed or damaged. Funding has been taken from education and healthcare, the inappropriately reshuffling of funding will compound negative social effects. Ultimately those effects are reflected in the Coroner’s business.

Anti-drug programs must be more general, addressing the root causes for use and/or abuse as well as heading off the use and abuse. Meth use is a problem, but only one among many. The use and abuse of cocaine and hallucinogens are bigger problems, and the non-prescriptive use of prescription painkillers is bigger still. Keeping kids in school, life-skills training to resist use and abuse, supporting families as the “anti-drug” (rather cliché, but true), and providing access to mental health caring and substance abuse early in its course are all things that can have real impact in decreasing drug use and abuse. They must be funded and supported.

Targeting and vilifying a single drug will lose more people than it will help. Drug use and abuse is a real problem that deserves more than a bandaid and more than a drug-of-the-month approach.

Meth Myth I

I will always stick by my line that: Drugs can make you high, drugs can make you die. I teach that as a fact. I have seen it in the ER and in the Coroner’s Office.

But just as the evils of “demon rum” were over-hyped in the 30s (I remember doing a dramatic interp reading on that topic in speech contests in high school), the evils of drugs (general and specific) can be over-hyped today. It does no one any good to over-do the presentation on the very serious problems associated with drug and alcohol use. When the “audience” can see even a bit of it as a lie, they will often assume that the whole thing is a lie and ignore it all. If you say using a certain drug will always lead to addiction or always lead to other drugs, or will cause the user to become some crazed drug-using fiend, the audience only has to know one individual (although they likely know several) for whom that is not true and your argument collapses like a house of cards.

I plan to write more on the current “meth madness” media blitz, but let me first throw out a link to SAMHSA data (Substance Abuse and Mental Health Services Administration) that demonstrates the likelihood that it is a growing epidemic is false with no raise in their stats of first time users 1971 through 2003. Don’t get me wrong, I do believe that meth is bad and that it is a problem, but I think we would be better served concentrating on the 2.7 million chronic cocaine users and 1 million heroin addicts in this country rather than a probably over-hyped “newsy” drug problem. Although strategies that decrease the use of a given drug very likely will decrease the use of other drugs.

War and Post-tramatic Stress

This is a topic I have been meaning to write about for some time. I have been carrying a couple of articles in my briefcase to draw from and did talk to someone from the local Navy base recently, reinforcing my impressions. An article I ran across today pushed it forward in my awareness.

This is a big problem that will rapidly become a huge problem. 5% (although I have seen higher numbers) of veterans returning from Iraq and Afghanistan have signs and symptoms of Post-Traumatic Stress Disorder. Granted it does range in severity among individuals and not all are severe, but 1 in 20 (or greater) is very concerning to me. What is worse is that only 22% (according to the Pentagon) are being referred for care/help. Everyone with the signs and symptoms should be, at the very least, professionally (i.e. mental health professional) evaluated once with access to further care as needed.

Escalating and significant problems with post-traumatic stress can lead to drug and/or alcohol abuse (self-medicating), psychiatric problems/mental illness, increased risk of suicide, increased risk of violence to others, even medical health problems (we are not isolated mind and body).

This is a big problem that is going to get bigger. We must prepare for it, we must deal with it. If it is not dealt with, it will compound. It will impact individuals’ morbidity and mortality. It will impact community morbidity and mortality. We must support our troops, after they come home as well as when they are in combat.

"Regular" teen drinking

Often my Internet browsing for blog material leads down a trail (short or long). I’ll stumble onto something interesting then follow links for more information or to track back and check source material, etc. This post is the result of just such a trail.

The Beachwood Reporter was critiquing an editorial about underage drinking that was in in the Chicago Tribune yesterday. They had a link to a critique of a study on which the editorial was drawn. The critique was in stats, a publication from George Mason University (interestingly I also got an email from someone at George Mason University today on another matter). The stats article was criticizing (quite justifiably it appears to me) a publication in the Archives of Pediatrics & Adolescent Medicine.

I present this “map” of my journey to write this post for several reasons. First, at least to partially justify the time I spend cruising Internet news and “newsy” sites. Second, to point out that you can’t believe everything you read/see, even in a scientific, peer-reviewed journal (always question, think, be critical, accept only if satisfied after that). Third and most important, to lay out the reason for this post, to put out a bit of important information:

“47.1% of [individuals] age 12-20 are “drinkers”, that is, they consume at least one drink [alcoholic beverage] per month”.

Teens (including very young teens) are regularly drinking alcohol in alarming numbers, particularly when you consider that the younger you start to drink the higher the risk for dependence and alcohol abuse for the rest of your life. So while not “everyone is doing it”, enough are that preventative steps/programs need to happen, need to be a high priority, or we are going to “lose” a lot of teens.

Children’s Mental Health Week

May is Mental Health Awareness Month and this is Children’s Mental Health Week. Across the nation people will be wearing green ribbons to increase awareness of children and adolescent mental health issues (personally I think the whole ribbon thing has been over-done). However, the issue is critically important.

According to information from the Illinois Federation of Families, 1 in 5 children and adolescents have a diagnosable mental health disorder, 1 in 10 have a serious impairment as a result of a mental health disorder. That is an incredible amount of disease. What is really upsetting, however, is that about 65% of children and adolescents in need of mental health services do not receive the care they need. A percentage of those end up in my office, preventable deaths. Treatment success rates in these individuals is 80%. Early detection and treatment for these individuals is highly likely to result in healthy, recovered lives. Lack of treatment, on the other hand, results in a high likelihood of dropping out of school, involvement in the juvenile (and later, adult) justice system, long-term problems and difficulties.

We all have to be involved in advocating for availability of services and fighting service cuts, advocating so that those that need help seek help, and fight the stigma that surrounds mental health care and mental illness. We wouldn’t put up with these numbers if we substituted some other diagnosis instead of “mental health disorder” above. An illness that has an 80% cure rate that isn’t being adequately treated would be front-page news, but apparently not so if it is mental illness.

Nick's Law in Iowa

I read in the Chicago Tribune last Friday that Nick’s Law “remained undone” as the Iowa Legislature adjourned. The feeling was that the law, intended to decrease teen motor vehicle death in Iowa, was too complex, addressed too many issues in one bill to get passed successfully. The issues covered seem to me to be in need of codification, including some we could use here in Illinois. Nick’s Law included: 1) restricting passengers in teen driven cars to one, other than family (although it my experience that family members can be just as distracting as friends), 2) expanding restricted hours of driving to 11 pm (from 12:30 am) to 5 am, except with work and school functions, 3) increase supervised, pre-license driving to 50 hours, 4) no cell phone use while driving, 5) extend requirement of seat belt usage for backseat passengers 18 years (from 11) and younger, 6) require keg registration (for tracking of who sold it and who bought it), 6) expand the criminal offense of providing alcohol to underage teen to include “knowingly permitting consumption or possession”, and 7) extend civil liability for damages resulting from an underage intoxicated person to anyone who knowingly and deliberately made alcohol available to that underage person.

Wow, that is a lot of territory covered in one bill, but all great issues that ought to considered in every jurisdiction in the country. Teens are even more distractible while driving than adults (yes it is a generalization) and they should have more restrictions placed on their privilege of driving. Something does need to be done to address the problem of underage drinking and its impact on teen driving deaths (albeit 30% of crashes), certainly these added restrictions are not onerous and should be considered (they have been tried with success in other states and locales).

It will be interesting to see if the bill is split up and tried in smaller packages. I certainly hope that nothing else happens in Iowa to add impetus to pushing it through as a package next session (Nick’s Law was introduced after the death of the son of a former Iowa legislator).

Disposition of Remains and Estate

Whether in a will or codicil (a P.S. to your will) or power of attorney (with an after death “expiration”) or some other written document, leave instructions on how you wish your remains “handled” after your death (e.g. burial or cremation), who should be “in charge” of ensuring you wishes are adhered to (your representative), and who is in charge of or will benefit from your estate.

As I have mentioned before, death and grieving (at times unfortunately spiced with a little greed and/or previous “hard feelings”) make surviving friends and family at least a little crazy. I have seen verbal “fights” about these issues, amazingly often. These fights can be long and drawn out or brief, up close or long distance, but they reek havoc and sow grief separate from the grieving over the death, as well as cause confusion, consternation and delay. Families and friends can be torn apart, relationships damaged. Death investigations can be impeded or drawn to inaccurate conclusions.

“Inoculate” against some of that post-mortem craziness. Write it down and make it easy to find for those that need that information after your death.

70% teen fatal crashes not intoxicated

At the pre-prom crash reenactment Wednesday the last speaker, Michael Karlin, (see Brakes for Brett), made the point that “only” 30% of teen fatal auto crashes involve alcohol and/or drugs (which is the opposite of adult statistics).

70% of teen fatal car crashes are not related to driving intoxicated or riding with someone who is intoxicated. Those crashes involve distraction, risk taking, bad choices, and, yes, some bad luck.

While it its important that we target and work to decrease underage drinking and its toll on teens (lethal and non-lethal), we must also figure out how to impact the causes of that 70% of fatal crashes especially. We need to educate/inform teens (and parents and the community) about what causes these crashes and how to prevent them from happening. That education/information must start well before teens start driving, it must be repeated, it must be realistic (not “scared straight”), it ought to be peer driven (and possibly peer presented), it must be someone with credibility (to the teens) and who has been there, and it must have demonstrated benefit (not just some cool, feel good rah-rah programming that looks good to parents or faculty). We ought to ask teens what they think will work.

Also, some of the prevention choices will need to be statutory and they will be tough to enact, e.g. stiffer penalties for 1st time offenses for “new” drivers and more restrictions on drivers less than 18 years old.

Teens are dying while using the most lethal equipment available in our society (the automobile). That dying must be stopped.

Psychic Investigator

Yesterday I attended a meeting of the Illinois Coroner and Medical Examiner Association held in conjunction with the Illinois Association of County Officials. One of the speakers at the Coroners’ meeting was a Psychic Investigator by the name of Noreen Renier. It was an interesting talk and certainly not one of your run-of-the-mill topics. I guess I haven’t paid enough attention to know that such individuals/occupations exist and that they often work successfully with law enforcement, particularly, I guess, because they rarely get credit for their help (especially public credit). And this is beyond the charlatans that often get media (media used loosely) splash, she has to overcome those as roadblocks in allowing her to do what she does, apparently quite successfully.

She has written a book, A Mind for Murder, about her life and some of the cases she has been involved in. I got a copy of the book yesterday, but have only read the “forward’ part. She “grew’ from doing a lounge act to helping with some very high profile cases, as well as many less well known cases including a recent case in McHenry County, IL. The Coroner from that County spoke “very positively” about her work and abilities. She works by psychometry, getting her impressions/information by touching objects connected to the crime/case or persons involved in the case. She reports “only” an 80% or so success rate (again in distinction with charlatans) and feels that use of a Psychic Investigator in crime cases should be a “last resort, when traditional methods for solving a crime have been exhausted”. She doesn’t “sell” herself or her services.

After seeing her and listening to her speak, and skimming her book, I’d have to say she and what she does is the real deal. I certainly can’t explain it, but neither can she. It happens, it works. Yet another occupation in Forensics, but one it seems that applies you as opposed to your applying for it.

I look forward to reading her book and do wish her continued success.